经尿道等离子前列腺解剖性剜除术与经尿道前列腺电切术治疗良性前列腺增生的疗效比较
|
摘要
目的:探讨经尿道等离子前列腺解剖性剜除术(transurethral anatomical enucleation of prostate,TUAEP)与经尿道前列腺电切术(transurethral resection of prostate,TURP)治疗良性前列腺增生(benign prostatic hyperplasia,BPH)的临床疗效。方法:120例BPH患者根据治疗时所用不同治疗方案分成TUAEP组和TURP组,每组60例。对比两种手术方式的手术时间、前列腺切除质量、术中出血量、术后持续膀胱冲洗时间、留置导尿管时间、术后住院时间及并发症,术后3个月国际前列腺症状评分(IPSS)、生活质量评分(QOL)、残余尿量(PVR)、最大尿流率(Qmax)等指标。结果:两组手术时间、术后3个月随访主要指标(IPSS、QOL、PVR)等方面比较,差异均无统计学意义(P>0.05)。TUAEP组术中出血量、术后持续膀胱冲洗时间、留置导尿管时间、术后住院时间方面均明显低于TURP组(P<0.05)。TUAEP组前列腺切除质量、Qmax增加值均明显高于TURP组(P<0.05)。TUAEP组术后二次出血率低于TURP组(P<0.05),但假性尿失禁发生率高于TURP组(P<0.05)。结论:TUAEP能够更彻底地切除增生前列腺腺体,术中出血少,术后恢复快,住院时间短,安全性高,并发症少,值得临床推广。
Objective:To investigate the clinical effect of transurethral anatomical enucleation of prostate(TUAEP)and transurethral resection of prostate(TURP) for treatment of benign prostatic hyperplasia.Method:A total of 120 patients with BPH were divided into TUAEP group and TURP group according to different operation methods,each group had 60 cases.The operation time,resected tissue weight,blood loss,bladder irrigation time,intubation time,postoperative hospitalization time and complications,the international prostate symptom score(IPSS),quality of life score(QOL),residual urine volume(PVR) and maximum urinary flow rate(Qmax) within 3 months after operation of two groups were compared.Result:There were no significant differences in the operation time and main indexes(IPSS,QOL,PVR) of the postoperative 3 months between two groups(P>0.05).The blood loss,bladder irrigation time,intubation time,postoperative hospitalization time of TUAEP group were significant lower than those of TURP group(P<0.05).The resected tissue weight and the increase of Qmax of TUAEP group were significantly higher than those of TURP group(P<0.05).The rate of secondary hemorrhage of TUAEP group was lower than that of TURP group(P<0.05),but the incidence of false incontinence was higher than that of TURP group(P<0.05).Conclusion:TUAEP can remove hyperplastic prostatic gland more thoroughly.It has less bleeding,quicker postoperative recovery,shorter hospitalization time,higher safety and less complications,it is worthy of clinical promotion.
Objective:To investigate the clinical effect of transurethral anatomical enucleation of prostate(TUAEP)and transurethral resection of prostate(TURP) for treatment of benign prostatic hyperplasia.Method:A total of 120 patients with BPH were divided into TUAEP group and TURP group according to different operation methods,each group had 60 cases.The operation time,resected tissue weight,blood loss,bladder irrigation time,intubation time,postoperative hospitalization time and complications,the international prostate symptom score(IPSS),quality of life score(QOL),residual urine volume(PVR) and maximum urinary flow rate(Qmax) within 3 months after operation of two groups were compared.Result:There were no significant differences in the operation time and main indexes(IPSS,QOL,PVR) of the postoperative 3 months between two groups(P>0.05).The blood loss,bladder irrigation time,intubation time,postoperative hospitalization time of TUAEP group were significant lower than those of TURP group(P<0.05).The resected tissue weight and the increase of Qmax of TUAEP group were significantly higher than those of TURP group(P<0.05).The rate of secondary hemorrhage of TUAEP group was lower than that of TURP group(P<0.05),but the incidence of false incontinence was higher than that of TURP group(P<0.05).Conclusion:TUAEP can remove hyperplastic prostatic gland more thoroughly.It has less bleeding,quicker postoperative recovery,shorter hospitalization time,higher safety and less complications,it is worthy of clinical promotion.
引文
[1]Lee Y T,Ryu Y W,Lee D M,et al.Comparative analysis of the efficacy and safety of conventional transurethral resection of the prostate,transurethral resection of the prostate in saline(TURIS),and TURIS-plasma vaporization for the treatment of benign prostatic hyperplasia:a pilot study[J].Korean J Urol,2011,52(11):763-768.
[2]刘春晓,徐啊白,邹勇.经尿道前列腺解剖性剜除术[J].现代泌尿外科杂志,2014,19(8):495-498.
[3]刘春晓.经尿道前列腺解剖性剜除术的研究进展[J].微创医学,2015,10(3):263-268.
[4]吴阶平.吴阶平泌尿外科学[M].济南:山东科学技术出版社,2004:1187-1197.
[5]Mamoulakis C,Ubbink D T,de la Rosette J J.Bipolar versus monopolar transurethral resection of the prostate:a systematic review and meta-analysis of randomized controlled trials[J].Eur Urol,2009,56(5):798-809
[6]Shimizu Y,Hiraoka Y,Iwamoto K,et al.Measurement of residual adenoma after transurethral resection of the prostate by transurethral enucleation technique[J].Urol Int,2005,74(2):102-107.
[7]张浩,司徒杰,李铭钊,等.侧入路4步法经尿道前列腺等离子解剖性剜除术治疗大体积前列腺增生[J].中华腔镜泌尿外科杂志电子版,2016,10(1):5-7.
[8]李传印,郑少波,刘春晓,等.经尿道逆行腔内剜除双极等离子体电切治疗复发性前列腺增生[J].现代泌尿外科杂志,2015,19(1):26-28.
[9]Ho H S,Yip S K,Lim K B,et al.A prospective randomized study comparing monopolar and bipolar transurethral resection of prostate using transurethral resection in saline(TURIS)system[J].Ear Urol,2007,52(2):517—522.
[10]刘春晓.传统经尿道前列腺电切术不应再是前列腺增生腔内治疗的金标准[J].现代泌尿外科杂志,2012,17(3):298-299.
[11]Neill M G,Gilling P J,Kennett K M,et al.Randomized trial comparing holmium laser enucleation of prostate with plasmakinetic enucleation of prostate for treatment of benign prostatic hyperplasia[J].Urology,2006,68(5):1020-1024.
[12]Ercil H,Altunkol A,Alma E,et al.Comparison of Ho:Yag laser and pneumatic lithotripsy combined with transurethral prostatectomy in high burden bladder stones with benign prostatic hyperplasia[J].Asian J Surg,2016,39(4):238-242.
[13]Xu Z,Liu J,Zheng X,et al.Protective effect of preserving bladder neck integrity on erectile function in patients undergoing plasmakinetic vaporization for benign prostatic hyperplasia[J].Nan Fang Yi Ke Da Xue Xue Bao,2014,34(11):1702-1704.
[14]刘春晓.实用经尿道手术学[M].北京:人民卫生出版社,2011:53-55.
[15]李传印,郑少波,刘春晓,等.经尿道逆行腔内剜除双极电切治疗巨大前列腺增生[J].实用医学杂志,2013,29(13):2174-2177.
[16]杨帝宽,刘春晓.经尿道前列腺剜除术[J/OL].中华腔镜泌尿外科杂志(电子版),2011,5(6):61-63.
[17]刘俊峰,刘春晓,谭朝晖,等.经尿道双极等离子前列腺剜除术与电切术后尿失禁发生率的随机对照研究[J].中华男科学杂志,2014,20(2):165-168.
[18]卞军,刘春晓,郑少波,等.经尿道前列腺等离子腔内剜除术与切除术治疗前列腺增生的临床对照研究[J].南方医科大学学报,2008,28(5):742-745.
[19]陈斌,郑嘉欣,张开颜,等.经尿道前列腺剜除术与电切术治疗不同质量良胜前列腺增生的前瞻性研究[J].中华泌尿外科杂志,2013,34(8):608-612.
[20]马海,李杨,周文奇,等.经尿道双极等离子腔内前列腺剜除术治疗前列腺增生症(附360例报告)[J].中国微创外科杂志,2016,16(6):495-497.
[21]李胜,曾宪涛,郭毅,等.经尿道等离子腔内剜除术与经尿道等离子双极电切术比较治疗良性前列腺增生的Meta分析[J].中国循证医学杂志,2011,11(10):1172-1183.
[2]刘春晓,徐啊白,邹勇.经尿道前列腺解剖性剜除术[J].现代泌尿外科杂志,2014,19(8):495-498.
[3]刘春晓.经尿道前列腺解剖性剜除术的研究进展[J].微创医学,2015,10(3):263-268.
[4]吴阶平.吴阶平泌尿外科学[M].济南:山东科学技术出版社,2004:1187-1197.
[5]Mamoulakis C,Ubbink D T,de la Rosette J J.Bipolar versus monopolar transurethral resection of the prostate:a systematic review and meta-analysis of randomized controlled trials[J].Eur Urol,2009,56(5):798-809
[6]Shimizu Y,Hiraoka Y,Iwamoto K,et al.Measurement of residual adenoma after transurethral resection of the prostate by transurethral enucleation technique[J].Urol Int,2005,74(2):102-107.
[7]张浩,司徒杰,李铭钊,等.侧入路4步法经尿道前列腺等离子解剖性剜除术治疗大体积前列腺增生[J].中华腔镜泌尿外科杂志电子版,2016,10(1):5-7.
[8]李传印,郑少波,刘春晓,等.经尿道逆行腔内剜除双极等离子体电切治疗复发性前列腺增生[J].现代泌尿外科杂志,2015,19(1):26-28.
[9]Ho H S,Yip S K,Lim K B,et al.A prospective randomized study comparing monopolar and bipolar transurethral resection of prostate using transurethral resection in saline(TURIS)system[J].Ear Urol,2007,52(2):517—522.
[10]刘春晓.传统经尿道前列腺电切术不应再是前列腺增生腔内治疗的金标准[J].现代泌尿外科杂志,2012,17(3):298-299.
[11]Neill M G,Gilling P J,Kennett K M,et al.Randomized trial comparing holmium laser enucleation of prostate with plasmakinetic enucleation of prostate for treatment of benign prostatic hyperplasia[J].Urology,2006,68(5):1020-1024.
[12]Ercil H,Altunkol A,Alma E,et al.Comparison of Ho:Yag laser and pneumatic lithotripsy combined with transurethral prostatectomy in high burden bladder stones with benign prostatic hyperplasia[J].Asian J Surg,2016,39(4):238-242.
[13]Xu Z,Liu J,Zheng X,et al.Protective effect of preserving bladder neck integrity on erectile function in patients undergoing plasmakinetic vaporization for benign prostatic hyperplasia[J].Nan Fang Yi Ke Da Xue Xue Bao,2014,34(11):1702-1704.
[14]刘春晓.实用经尿道手术学[M].北京:人民卫生出版社,2011:53-55.
[15]李传印,郑少波,刘春晓,等.经尿道逆行腔内剜除双极电切治疗巨大前列腺增生[J].实用医学杂志,2013,29(13):2174-2177.
[16]杨帝宽,刘春晓.经尿道前列腺剜除术[J/OL].中华腔镜泌尿外科杂志(电子版),2011,5(6):61-63.
[17]刘俊峰,刘春晓,谭朝晖,等.经尿道双极等离子前列腺剜除术与电切术后尿失禁发生率的随机对照研究[J].中华男科学杂志,2014,20(2):165-168.
[18]卞军,刘春晓,郑少波,等.经尿道前列腺等离子腔内剜除术与切除术治疗前列腺增生的临床对照研究[J].南方医科大学学报,2008,28(5):742-745.
[19]陈斌,郑嘉欣,张开颜,等.经尿道前列腺剜除术与电切术治疗不同质量良胜前列腺增生的前瞻性研究[J].中华泌尿外科杂志,2013,34(8):608-612.
[20]马海,李杨,周文奇,等.经尿道双极等离子腔内前列腺剜除术治疗前列腺增生症(附360例报告)[J].中国微创外科杂志,2016,16(6):495-497.
[21]李胜,曾宪涛,郭毅,等.经尿道等离子腔内剜除术与经尿道等离子双极电切术比较治疗良性前列腺增生的Meta分析[J].中国循证医学杂志,2011,11(10):1172-1183.